Gastro/Endocrine/Renal/Haem Flashcards
What are some specific symptoms you should ask about in a GI history?
Dysphagia/odynophagia, nausea/vomiting/haematemasis, abdominal pain/bloating, altered bowel habit/PR bleeding, jaundice
If a female patient presents with abdominal pain, what other things must you remember to ask them?
Is there any chance they could be pregnant? - remember to screen for gynae/obstetric problems
If a patient presents with jaundice, what are some extra things to ask about?
Have they travelled abroad recently? Have they had any tattoos/piercings recently? Have they had unprotected sex recently? (particularly new partner/high risk activity)
What gastrointestinal conditions can finger clubbing be a sign of?
IBD, cirrhosis, coeliac disease
What is leuconychia a sign of?
Hypoalbuminaemia
Scleral icterus implies a serum level of bilirubin greater than what?
35
Where is Virchow’s node and what is the significance of it?
Left supraclavicular area - suggestive of gastric cancer
The presence of how many spider naevi is suggestive of chronic liver disease?
5 or more
In addition to oedema, what are some extra skin changes to look for on the calves of someone with potential gastrointestinal disease?
Erythema nodosum or pyoderma gangrenosum
How do you assess for shifting dullness?
Percuss from the umbilicus to the opposite flank- if dullness is detected, ask the patient to roll towards you, wait 10 seconds and the re-percuss
The presence of shifting dullness suggests what?
Ascites
Where should you auscultate for bowel sounds?
Just below the umbilicus
Where should you auscultate for renal bruit?
Superior and lateral to the umbilicus
Where should you auscultate for aortic bruit?
Superior to the umbilicus
After finishing an abdominal examination, you may wish to mention that you would perform which further examinations?
Hernial orifices, PR, male/female genitalia
Where will a transplanted kidney be found?
Right or left iliac fossa
If you suspect fluid overload in an individual with gastrointestinal/renal disease, what is a useful thing to examine out with these systems?
Lung bases for pulmonary oedema
What is the ideal position for a patient to be in when you examine for hernias?
Standing upright
What should you always ask patients to do when examining a possible hernia?
Cough
What are the main symptoms you should ask about during a urological history?
Dysuria, haematuria, frequency/nocturia, incontinence, urgency, hesitancy/poor stream/terminal dribbling
What are the main symptoms you should ask about if you suspect haematological disease?
Shortness of breath/dizziness/pallor, bleeding/bruising, recurrent infections and systemic symptoms
If you are asked to do a warfarin review, what are the first things you should clarify?
Why are they on warfarin and what is their INR
When should warfarin be taken?
At the same time every day
What should you advise patients to do if they miss one dose of warfarin?
Take it as soon as they remember, unless it is the next day in which case the dose should be omitted and they should contact their doctor
When patients start warfarin, you should inform them to seek help if they experience what skin changes?
Jaundice or painful, swollen areas of skin
What are some examples of foods that decrease the effect of warfarin (increased risk of clotting)?
Kale, broccoli, spinach
What are some examples of foods that increase the effect of warfarin (increased risk of bleeding)?
Cranberry and grapefruit juice, alcohol
What should you do if a patient on warfarin has an INR of 5-8 but is not actively bleeding?
Withhold 1 or 2 doses of warfarin and reduce the maintenance dose
What should you do if a patient on warfarin has an INR of 5-8 with minor bleeding?
Withhold warfarin, give an IV injection of vitamin K, restart warfarin when INR is < 5
What should you do if a patient on warfarin has an INR > 8 but is not actively bleeding?
Withhold warfarin, give oral vitamin K, restart when INR is < 5
What should you do if a patient on warfarin has an INR > 8 with minor bleeding?
Withhold warfarin, give IV injection of vitamin K, restart warfarin when INR is < 5
What should you do if a patient on warfarin experiences major bleeding?
Withhold warfarin, give IV vitamin K, give IV prothrombin complex concentrate or FFP
What specific symptoms should you ask about in a CKD review history?
Ankle swelling, itch, nausea/vomiting, urinary symptoms, systemic symptoms
